EBOLA

Ebola is a relatively new disease. It was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, there have been several outbreaks of the disease, however, until now the disease has been confined to Africa (although there have been a few deaths elsewhere due to contamination in laboratories). It is believed that “patient zero” of a particular outbreak catches the virus from contact with bat detritus.

The current outbreak is the largest and most dangerous ever, based on the number of cases and the geographic areas affected. Although the primary affected area is West Africa – Liberia, Guinea, Sierra Leone and Nigeria – it has spread to other locales, such as the US and Spain. The CDC, WHO and other relief agencies have been working diligently to contain the disease, but heretofore, it appears they are playing catch-up. WHO has warned that within two months West Africa could be facing up to 10,000 cases a week. Even worse, the death rate has been approximately 70%. I repeat, 70%, although part of that is due to the relatively primitive level of healthcare in West Africa. (In some areas, patients still consult witch doctors for medical issues.) Although comparisons could be misleading, by contrast the death rate during the Flu Pandemic in 1918, which caused widespread panic and killed an estimated 30 – 50 million people worldwide, was only 2%; in the 14th century, the so-called Black Death pandemic killed over 100 million people in Europe, which was about 1/3 of its population at the time.

Some facts and figures about Ebola and the current outbreak:

1. There is no FDA-approved vaccine or medication for it.

2. Treatment consists primarily of providing fluids intravenously, careful monitoring of blood pressure and oxygen levels, and treating any ancillary infections that may occur. These are not actual cures per se, but they serve to keep the patient alive until his body can develop its own antibodies to fight off the disease.

3. As always, early detection and strong supportive care are critical. All of the above are generally lacking in West Africa.

4. Survivors of the disease develop antibodies that last for at least ten years, although it is not known whether or not they can subsequently be infected with another strain of the disease prospectively. Additionally, some survivors have been known to develop other medical problems, such as joint or vision problems.

5. On the plus side, a blood transfusion from a survivor can be an effective treatment for a new patient. In point of fact, in Dallas one of the infected nurses is receiving such a transfusion.

6. Medical professionals have cautioned against panic, stating that Ebola can only be transmitted through direct contact. I agree that we should refrain from panicking, but there are many ways one can become infected, some of which one might not realize.

a. “Direct contact” includes not only means one would expect, such as touching the blood, semen, urine, saliva, sweat, vomit, feces and breast milk of an infected person, but also if an infected person sneezes or coughs on you.

b. The virus can survive in the open for several hours, if not days. Thus, it can be transmitted by a handshake, stepping in a puddle, or touching a dry surface, such as a door knob, needles, clothing or bedding. Family members and healthcare providers are at the greatest risk. Transmission on an airplane certainly seems plausible, though not likely. Furthermore, it is more than a little disconcerting that nurses have caught the disease despite wearing protective gear.

7. Speaking of airplane flights, it has been proposed that the US suspend all flights from West African nations and deny entry to any persons holding passports or visas from a West African country at least until the situation is under control. This would insulate Americans better and alleviate health concerns. I am in favor of this. I think it is unrealistic to expect untrained airport and airline personnel to be capable of screening passengers for Ebola symptoms. It is dangerous for the screeners and creates a false sense of security for the public.

CONCLUSION

The CDC and US government must step up their game. The CDC appears to have been caught off-guard by the severity of this outbreak and is still playing catch-up. They must be honest with the American people. CDC Director Tom Frieden’s conflicting and illogical justifications for not suspending flights from infected areas have not exactly inspired confidence. Most people are in favor of suspending flights from infected areas or at least quarantining them. There is precedent for that (Ellis Island).

Many people have sensed that Frieden is presenting an overly optimistic or even unrealistic picture of the situation. I understand the government doesn’t want to create panic, but don’t sugarcoat it either. Polls show that about half the people believe the government is withholding information, and it makes them uneasy.

The present Ebola outbreak is definitely the most severe since the disease was first discovered in 1976. It has the potential to become as devastating as the Flu Pandemic of 1918, however, through modern healthcare facilities and techniques we have the means to contain it. Literally, the old adage “an ounce of prevention is worth a pound of cure” applies here. The key is prompt, comprehensive and decisive action.

The situation remains very fluid. I will provide updates when, as and if necessary.